| NPI | 1700086188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: PA AK000628) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019002) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-01-23 |